§ 6-09-47 — Medical facility infrastructure loan fund - Medical facility infrastructure loan program - Rural health loan program - Medical facility emergency operating loan program - Continuing appropriation - Audit and costs of administration (Effective through June 30, 2027)

program - Rural health loan program - Medical facility emergency operating loan
program - Continuing appropriation - Audit and costs of administration. (Effective
through June 30, 2027)
1. The Bank of North Dakota shall administer a medical facility infrastructure loan
program to provide loans to medical facilities to conduct construction that improves the
health care infrastructure in the state or improves access to existing nonprofit health
care providers in the state. The construction project may include land purchases and
may include purchase, lease, erection, or improvement of any structure or facility to

the extent the governing board of the health care facility has the authority to authorize
such activity.
2. In order to be eligible under the medical facility infrastructure loan program, the
applicant must be the governing board of the health care facility which shall submit an
application to the Bank. The application must:
a. Detail the proposed construction project, which must be a project of at least
one million dollars and which is expected to be utilized for at least thirty years;
b. Demonstrate the need and long-term viability of the construction project; and
c. Include financial information as the Bank may determine appropriate to determine
eligibility, such as whether there are alternative financing methods.
3. A medical facility infrastructure loan provided under this section:
a. May not exceed the lesser of fifteen million dollars or seventy-five percent of the
actual cost of the project;
b. Must have an interest rate equal to two percent; and
c. Must provide a repayment schedule of no longer than twenty-five years.
4. A recipient of a medical facility infrastructure loan under this section shall complete the
financed construction project within twenty-four months of approval of the loan. Failure
to comply with this subsection may result in forfeiture of the entire loan received under
this section.
5. The Bank shall administer a rural health loan program to provide short-term gap
financing to grant recipients under the federal rural health transformation program with
approved projects and a demonstrated financial need.
a. To be eligible for a rural health loan under this subsection, the applicant:
(1) Must be approved for a grant by the department of health and human
services and the centers for Medicare and Medicaid services, as applicable,
under the federal rural health transformation program based on policies
developed by the department of health and human services.
(2) Provide information as requested by the Bank, including information
substantiating a demonstrated financial need and evidence of project
approval from the department of health and human services under the
federal rural health transformation program.
b. A loan under this subsection must have:
(1) An annual interest rate that does not exceed two percent;
(2) A term that complies with the criteria established by the department of
health and human services, in accordance with the federal rural health
transformation program, and does not exceed three years.
c. From the repayment of loans under this subsection, the principal portion must be
used to replenish the Bank's profits which were transferred to the fund for the
loans under this program, and interest portion must be deposited in the fund.
6. The Bank shall administer a medical facility emergency operating loan program to
provide emergency operating loans to local nonprofit hospitals located in cities with a
population of fewer than two thousand five hundred according to the most recent
decennial census.
a. To be eligible for an emergency operating loan under this subsection, the
governing board of a health care facility shall:
(1) Submit an application to the Bank by March 31, 2026;
(2) Provide financial information as requested by the Bank to determine
eligibility, including information on alternative financing and other funding
sources; and
(3) Provide an updated operating plan and cash flow projections indicating the
feasibility of future operations after restructuring and sufficient financial
resources to address any operating deficit and to repay the loan.
b. A medical facility emergency operating loan under this subsection:
(1) May not exceed five million dollars per qualified applicant;
(2) Must have an annual interest rate that does not exceed two percent; and

(3) Must have a maximum term that does not exceed eleven years, unless a
shorter term is required based on an analysis by the Bank, with the first year
of the loan eligible for interest-only payments.
7. The medical facility infrastructure loan fund is a special fund in the state treasury. This
fund is a revolving fund. All moneys transferred into the fund, interest on moneys in the
fund, and collections of principal and interest on loans from the fund are appropriated
to the Bank on a continuing basis for the purpose of providing loans under this section.
8. Moneys in the fund may be used for loans as provided under this section and to pay
the costs of administration of the fund. Annually, the Bank may deduct a service fee for
administering the fund.
9. The fund must be audited in accordance with section 6-09-29. The cost of the audit
and any other actual costs incurred by the Bank on behalf of the fund must be paid
from the fund.
10. The Bank shall deposit medical facility infrastructure loan repayments in the fund.
Medical facility infrastructure loan fund - Medical facility infrastructure loan program -
Rural health loan program - Continuing appropriation - Audit and costs of administration.
(Effective after June 30, 2027)
1. The Bank of North Dakota shall administer a medical facility infrastructure loan
program to provide loans to medical facilities to conduct construction that improves the
health care infrastructure in the state or improves access to existing nonprofit health
care providers in the state. The construction project may include land purchases and
may include purchase, lease, erection, or improvement of any structure or facility to
the extent the governing board of the health care facility has the authority to authorize
such activity.
2. In order to be eligible under the medical facility infrastructure loan program, the
applicant must be the governing board of the health care facility which shall submit an
application to the Bank. The application must:
a. Detail the proposed construction project, which must be a project of at least one
million dollars and which is expected to be utilized for at least thirty years;
b. Demonstrate the need and long-term viability of the construction project; and
c. Include financial information as the Bank may determine appropriate to determine
eligibility, such as whether there are alternative financing methods.
3. A medical facility infrastructure loan provided under this section:
a. May not exceed the lesser of fifteen million dollars or seventy-five percent of the
actual cost of the project;
b. Must have an interest rate equal to two percent; and
c. Must provide a repayment schedule of no longer than twenty-five years.
4. A recipient of a medical facility infrastructure loan under this section shall complete the
financed construction project within twenty-four months of approval of the loan. Failure
to comply with this subsection may result in forfeiture of the entire loan received under
this section.
5. The Bank shall administer a rural health loan program to provide short-term gap
financing to grant recipients under the federal rural health transformation program with
approved projects and a demonstrated financial need.
a. To be eligible for a rural health loan under this subsection, the applicant:
(1) Must be approved for a grant by the department of health and human
services and the centers for Medicare and Medicaid services, as applicable,
under the federal rural health transformation program based on policies
developed by the department of health and human services.
(2) Provide information as requested by the Bank, including information
substantiating a demonstrated financial need and evidence of project
approval from the department of health and human services under the
federal rural health transformation program.
b. A loan under this subsection must have:
(1) An annual interest rate that does not exceed two percent;

(2) A term that complies with the criteria established by the department of
health and human services, in accordance with the federal rural health
transformation program, and does not exceed three years.
c. From the repayment of loans under this subsection, the principal portion must be
used to replenish the Bank's profits which were transferred to the fund for the
loans under this program, and interest portion must be deposited in the fund.
6. The medical facility infrastructure loan fund is a special fund in the state treasury. This
fund is a revolving fund. All moneys transferred into the fund, interest on moneys in the
fund, and collections of principal and interest on loans from the fund are appropriated
to the Bank on a continuing basis for the purpose of providing loans under this section.
7. Moneys in the fund may be used for loans as provided under this section and to pay
the costs of administration of the fund. Annually, the Bank may deduct a service fee for
administering the fund.
8. The fund must be audited in accordance with section 6-09-29. The cost of the audit
and any other actual costs incurred by the Bank on behalf of the fund must be paid
from the fund.
9. The Bank shall deposit medical facility infrastructure loan repayments in the fund.